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 Image by Emilian Danaila from Pixabay First published in Bipolar Life's April 2020 newsletter INTRODUCTIONMost people living with bipolar disorder understand the importance of medication in the management of their condition. We know that medications are to be taken lifelong, with a few exceptions. We also understand that they are taken in addition to, not as a replacement for, other treatments such as psychotherapy, healthy lifestyle and a good routine; this includes a good sleep pattern, regular exercise, good nutrition and strong social support. So, what happens if we don’t treat bipolar disorder in the right way, for instance self-treating? The following scenarios could happen [1]:
Therefore, it makes sense for you to work with your doctor to ensure the medications prescribed are right for you. As all medications can cause side effects, it is essential to be open and honest with your prescribing doctor if you are experiencing any problems. It is inadvisable to reduce or stop a medication without consulting with your doctor first. In this article we are going to look at:
Bipolar disorder is treated with three main classes of medication: mood stabilisers, antipsychotics and antidepressants. Sometimes your doctor may prescribe (usually short term) anti-anxiety and sleep aids–benzodiazepines and Z drugs. In this article we won’t go into much detail how they are used, such as acute treatment versus maintenance, or what is used for mania versus depression. Instead we’ll just concentrate on the side effects aspect to keep the article reasonably short. MOOD STABILISERS – LITHIUM [1,5]Around 75% of people of people taking lithium for bipolar disorder get side effects [2]. It is effective for mania, and is gold standard for maintenance therapy, and may help bipolar depression [1]. Important note on lithium toxicity This can be caused by various factors such as taking too many tablets, dehydration, or having a sudden drop in kidney function. This can be a dangerous condition and needs urgent medical attention. Symptoms can include nausea, vomiting, diarrhoea, drowsiness, unsteadiness, confusion, agitation, blurred vision, severe tremors, muscle jerks or seizures [4]. People taking lithium are recommended to have regular blood tests to check lithium levels, kidney and thyroid function [5]. How to avoid dehydration To avoid dehydration, it’s important to keep well hydrated especially if exercising, or in hot weather. Try not to have too much caffeine or alcohol as they can dehydrate. Medications such as diuretics and non-steroidal anti-inflammatory drugs (such as ibuprofen) can also cause lithium levels to rise so care is needed. We’ll now look at the anticonvulsants which are also used as mood stabilisers. MOOD STABILISERS – ANTICONVULSANTS [1,6]Important note on Stevens-Johnson syndrome This is a rare, serious disorder of the skin and mucous membranes. It usually begins with flu-like symptoms (such as fever, fatigue, cough), then a red or purplish blistering rash that spreads over the body. The mouth, eyes, nose and genitals can be affected [7]. You must seek immediate medical attention if you suspect you are having this reaction to a medication. ANTIPSYCHOTICS [1,8]The first antipsychotics developed, now known as first-generation typical antipsychotics (FGA), were used to treat people with schizophrenia in the 1950s. The second-generation antipsychotics (SGA) came out in the 1980s, and are commonly known as atypical antipsychotics [9]. The SGAs are helpful in reducing mania and in strengthening antidepressant treatment [1]. The SGAs generally are far less likely to cause a particular class of side effects, the extrapyramidal side effects such as restlessness, muscle stiffness, involuntary neck spasm, Parkinson’s like movements, involuntary facial and mouth movements [10]. It is recommended that people taking antipsychotics should have 6-12 monthly monitoring to check weight, blood pressure, fasting glucose and cholesterol, and ECG (heart trace) [11]. ANTIDEPRESSANTS [1,12]Treating depression in someone with bipolar disorder is less straightforward than for unipolar depression. For instance, in type 1 bipolar, antidepressants may be less effective [1]. Also, mania can be triggered by use of an antidepressant, particularly if the person is not also taking a mood stabiliser. There are several classes of antidepressant. Some of their brain actions are similar, some are different, and this is reflected in the differing side effect profiles in the table below.  There are some less commonly used antidepressants available in Australia. These include mirtazapine, trazodone, the Tricyclic Antidepressants (TCAs, such as amitriptyline and nortriptyline) and MAOIs (monoamine oxidase inhibitors such as phenelzine and tranylcypromine). You can read more about TCAs here [15] and MAOIs here [16]. ANTI-ANXIETY AND SLEEP MEDICATIONSAnti-anxiety medications (anxiolytics) and sleep aids (hypnotics) can be immensely helpful in the acute phase of depression and mania treatment. These are generally within the class of benzodiazepines (such as diazepam, temazepam, lorazepam) or Z drugs (such as zopiclone, zolpidem). Both benzodiazepines (“benzos” for short) and Z drugs pose a risk of dependence, so these medications are usually prescribed for as short a time as possible. Some people do require them longer term, but this requires strict monitoring by their doctor. Side effects can range from mild to severe. This can include daytime sedation, or impaired ability to drive, operate machinery or perform certain tasks. In overdose, or if taken with certain other drugs (prescribed, over-the-counter or illicit), or alcohol, adverse effects can be severe and even result in coma or death. The elderly are also at particular risk from these medications. It is possible to become dependent after just a few weeks of taking them regularly [17]. Signs of this process happening include:
Withdrawal from benzos needs to be done with regular review by your doctor. Some people can feel unwell if reducing too quickly, and may experience agitation, insomnia, hallucinations and seizures [17]. WHO MIGHT BE AT INCREASED RISK FOR SIDE EFFECTS?Older people are less able to metabolise their medications through the kidney and liver. At any age, but often more commonly seen in the elderly, being on a cocktail of medications can increase the risk for drug interactions and adverse effects. This is an important issue that needs regular monitoring by their doctor [20]. People who have pre-existing medical conditions may find them aggravated by weight gain, increased glucose or cholesterol. These conditions include high blood pressure, heart disease, history of stroke, diabetes, liver disease, kidney disease and arthritis. Substance use disorder can be seen in one-third to one-half of people with bipolar disorder [1]. People who drink alcohol, particularly if in excess of recommended levels, or take illicit drugs, may be at higher risk for side effects–in addition to the drugs and alcohol potentially worsening control of their bipolar disorder. Alcohol may cause dangerous interactions, especially when taken with lithium and benzodiazepines [1]. WHAT TO DO IF YOU ARE EXPERIENCING SIDE EFFECTSKeeping a journal when you start or change a drug regimen can be helpful in working out if a symptom is really a side effect or whether it is the illness, or something else entirely. If you think you are getting side effects, regardless of whether they are new or longstanding, it is a good idea to check in with your doctor. It might be decided that they side effects are mild and non-serious, and the benefits of the medication outweigh the adverse effects, in which case you could opt to continue. Possible other scenarios include:
TIPS FOR SPECIFIC SIDE EFFECTSHere are some tips for specific issues. Once again, these are ideas for you to discuss with your doctor first. TREMOR [3]
NAUSEA [3]
SEDATION [1]
WEIGHT GAIN
SEXUAL DYSFUNCTION
MEMORY AND COGNITIVE ISSUES [3]
HAIR LOSS (SODIUM VALPROATE]
ConclusionMedication is vital to most people’s bipolar treatment plan. It is important to be aware of possible side effects and to bring them to your doctor’s attention as soon as possible, so that you can both decide on the best course of action for your health. If you think this article might help someone else too, please like and share. All content within this article is for informational purposes only and is not intended to serve as a substitute for individual consultation with a qualified physician. References1. Fink, C. and Kraynak, J., 2016. Bipolar Disorder for Dummies. 3rd ed. New Jersey, USA: John Wiley & Sons, Inc. 2. WebMD. 2018. Lithium for Bipolar Disorder. [ONLINE] Available at: https://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-lithium#2. [Accessed 22 March 2020]. 3. UpToDate. 2019. Bipolar disorder in adults and lithium: Pharmacology, administration, and management of side effects. [ONLINE] Available at: https://www.uptodate.com/contents/bipolar-disorder-in-adults-and-lithium-pharmacology-administration-and-management-of-side-effects?search=lithium&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H182696807. [Accessed 22 March 2020]. 4. UpToDate. 2018. Lithium poisoning. [ONLINE] Available at: https://www.uptodate.com/contents/lithium-poisoning?search=lithium&topicRef=15317&source=see_link#H5. [Accessed 22 March 2020]. 5. UpToDate. 2019. Unipolar depression in adults: Treatment with lithium. [ONLINE] Available at: https://www.uptodate.com/contents/unipolar-depression-in-adults-treatment-with-lithium?search=lithium&source=search_result&selectedTitle=4~148&usage_type=default&display_rank=3#H2519581674. [Accessed 22 March 2020]. 6. UpToDate. 2020. Antiseizure drugs: Mechanism of action, pharmacology, and adverse effects. [ONLINE] Available at: https://www.uptodate.com/contents/antiseizure-drugs-mechanism-of-action-pharmacology-and-adverse-effects?search=valproate&source=search_result&selectedTitle=3~148&usage_type=default&display_rank=2#H1398705747. [Accessed 22 March 2020]. 7. Mayo Clinic. 2018. Stevens-Johnson syndrome. [ONLINE] Available at: https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/symptoms-causes/syc-20355936. [Accessed 22 March 2020]. 8. UpToDate. 2020. Second-generation antipsychotic medications: Pharmacology, administration, and side effects. [ONLINE] Available at: https://www.uptodate.com/contents/second-generation-antipsychotic-medications-pharmacology-administration-and-side-effects?search=antipsychotic&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H466014692. [Accessed 22 March 2020]. 9. National Center for Biotechnology Information. 2012. First-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness [Internet].. [ONLINE] Available at: https://www.ncbi.nlm.nih.gov/books/NBK107237/. [Accessed 22 March 2020]. 10. UpToDate. 2020. Second-generation antipsychotic medications: Pharmacology, administration, and side effects. [ONLINE] Available at: https://www.uptodate.com/contents/second-generation-antipsychotic-medications-pharmacology-administration-and-side-effects?search=extrapyramidal%20side%20effects&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H191681745. [Accessed 22 March 2020]. 11. National Prescribing Service Limited. 2011. Antipsychotic monitoring tool. [ONLINE] Available at: https://resources.amh.net.au/public/antipsychotic-monitoring-tool.pdf. [Accessed 22 March 2020]. 12. Hu, X., 2004. Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate.. Journal of Clinical Psychiatry, [Online]. 65(7), 959-65. Available at: https://www.ncbi.nlm.nih.gov/pubmed?term=15291685 [Accessed 22 March 2020]. 13. UpToDate. 2020. Serotonin-norepinephrine reuptake inhibitors (SNRIs): Pharmacology, administration, and side effects. [ONLINE] Available at: https://www.uptodate.com/contents/serotonin-norepinephrine-reuptake-inhibitors-snris-pharmacology-administration-and-side-effects?search=venlafaxine§ionRank=1&usage_type=default&anchor=H276509267&source=machineLearning&selectedTitle=2~148&display_rank=1#H18324389. [Accessed 22 March 2020]. 14. UpToDate. 2020. Serotonin-norepinephrine reuptake inhibitors (SNRIs): Pharmacology, administration, and side effects. [ONLINE] Available at: https://www.uptodate.com/contents/serotonin-norepinephrine-reuptake-inhibitors-snris-pharmacology-administration-and-side-effects?search=duloxetine§ionRank=1&usage_type=default&anchor=H1409194297&source=machineLearning&selectedTitle=3~99&display_rank=2#H1409194297. [Accessed 22 March 2020]. 15. myDr.com.au. 2018. Tricyclic antidepressants. [ONLINE] Available at: https://www.mydr.com.au/mental-health/tricyclic-antidepressants. [Accessed 22 March 2020]. 16. myDr.com.au. 2018. Monoamine oxidase inhibitors (MAOIs) for depression. [ONLINE] Available at: https://www.mydr.com.au/mental-health/monoamine-oxidase-inhibitors-maois-for-depression. [Accessed 22 March 2020]. 17. benzo.org.uk. 2002. Benzodiazepines: how they work and how to withdraw. [ONLINE] Available at: https://www.benzo.org.uk/manual/bzcha00.htm. [Accessed 22 March 2020]. 18. Patient. 2017. Benzodiazepines and Z Drugs. [ONLINE] Available at: https://patient.info/mental-health/insomnia-poor-sleep/benzodiazepines-and-z-drugs. [Accessed 22 March 2020]. 19. WebMD. 2019. Benzodiazepine Abuse. [ONLINE] Available at: https://www.webmd.com/mental-health/addiction/benzodiazepine-abuse#2. [Accessed 22 March 2020]. 20. Dols, A., 2013. The prevalence and management of side effects of lithium and anticonvulsants as mood stabilizers in bipolar disorder from a clinical perspective: a review.. International Clinical Psychopharmacology, [Online]. 28(6), 287-96. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23873292 [Accessed 22 March 2020]. 21. Nelson, J., 2017. Mindful Eating: The Art of Presence While You Eat. Diabetes Spectrum, [Online]. 30(3), 171–174. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556586/ [Accessed 22 March 2020]. 22. Better Health Channel. 2012. Weight loss - a healthy approach. [ONLINE] Available at: https://www.betterhealth.vic.gov.au/health/healthyliving/weight-loss-a-healthy-approach. [Accessed 22 March 2020]. 23. NHS. 2019. Start losing weight. [ONLINE] Available at: https://www.nhs.uk/live-well/healthy-weight/start-losing-weight/. [Accessed 22 March 2020]. 24. La Torre, A., 2013. Sexual dysfunction related to psychotropic drugs: a critical review part II: antipsychotics.. Pharmacopsychiatry, [Online]. 46(6), 201-8. Available at: https://www.ncbi.nlm.nih.gov/pubmed?term=23737244 [Accessed 22 March 2020]. 25. Kakunje, A., 2018. Valproate: It's [sic] Effects on Hair. International Journal of Trichology, [Online]. 10(4), 150–153. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192236/ [Accessed 22 March 2020]. @BipolarLifeVic @finkshrink @WebMD @UpToDate @MayoClinic @NPSMedicineWise @mydrwebsite
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First published on Hepatitis Australia's website in January 2020  Image by marker_photography from Pixabay “Detox diets”, supplements and Traditional Chinese Medicine are marketed as beneficial for the liver, but do they work? First let’s look at where the liver is and what it does. Liver anatomyIts functions include:
Detox dietsAlso known as a liver cleanse or flush, some people believe a detox diet helps remove excess waste after too much alcohol, unhealthy foods, or just for daily liver health. The first days may begin with fasting or drinking fluids only. Most detox diets take out processed food from your diet and may include commercial products, such as herbal supplements. Some people feel better on these diets, often simply due to eating more healthily. This might cause them to believe that the liver cleanse works, but it’s important to consider the following:
For most people following a healthy lifestyle, the liver is well equipped to remove day-to-day toxins and you don’t need to do a detox. SupplementsSome studies in animals show milk thistle decreases liver inflammation, and turmeric protects against liver injury. However, there haven’t been enough studies done on humans to recommend their use in prevention of liver disease [4]. The US National Center for Complementary and Integrative Health (NCCIH) advises that milk thistle can cause allergic reactions in some people or low blood sugar in people living with diabetes [5]. We should also remember that detox products and liver supplements may not be standardised. Products could have different strengths and be of varying quality. Some may interact with medication or have side effects including causing liver damage. Traditional Chinese MedicineTraditional Chinese Medicine (TCM) views the liver in terms of vital energy (qi) and the storage of blood (xue). Together with the scheme of Yin Yang, TCM practitioners may diagnose liver disorders, and offer treatments like acupuncture or herbs [6]. There is no evidence that acupuncture helps people with liver conditions. However, it is relatively safe if performed correctly [7]. Because there have been very few good quality studies, we have no strong proof that Chinese herbal products work for liver health. Some products have also been found to have been contaminated with plant or animal material, drugs like the blood-thinner warfarin, and heavy metals like arsenic. Some products can even contain the wrong herbs, which may damage the liver [8]. Therefore, it is very important that you are confident of what is in the Chinese herbs you buy. If you decide to use Chinese herbs or other supplements, it is advisable that you talk to your doctor, especially if you have hepatitis B or C, or other chronic diseases. Finally, the best way to look after your liver is maintain a healthy weight, follow a balanced diet, exercise regularly, minimise alcohol intake, and avoid smoking. If you think this article might help someone else too, please like and share. References
 First published on Bipolar Life's website in November 2019 Do you already use supplements, or are you thinking of trying some for your bipolar disorder? A study in the USA found that one in five people with bipolar used a supplement long term. The most commonly taken supplements were fish oil, B vitamins, melatonin and multivitamins[1]. Even with such popular usage and marketing messages like “safe” and “natural”, one should bear in mind that many supplements:
In addition:
Because the amount of information can be quite confusing, in this article we’ll try to summarise current knowledge. You can read all the way through or just skip to the section that most interests you. Abbreviations are expanded in the footnotes. As an aside, diet and supplements are not recommended as replacements for medication. However, there is hope that in the future, individual dosing could be used to minimise or possibly eliminate medication, according to Dr William Walsh, scientist and expert in nutritional medicine of the Walsh Research Institute[3]. SupplementsOmega-3 fatty acids Omega-3 fatty acids are nutrients that are naturally occurring and found in the form of EPA and DHA in foods like salmon, tuna, sardines, free-range chicken and omega-3 fortified eggs. A third form of omega-3 called ALA is found in dark green leafy vegetables like spinach, walnuts, flaxseeds and soybean. Only small amount of dietary ALA can be converted into useful EPA and DHA. It is thought most people in the United States get enough ALA from the foods they eat, as well as small amounts of EPA and DHA[5]. Some research suggests that there is body inflammation in acute mania, and to a lesser extent, in bipolar depression[4]. It is possible that omega-3 fatty acids may reduce inflammation in the nervous system[8]. However, though there are conflicting studies on whether omega-3 helps treat or prevent episodes of mania or depression[6], Dr. Jeffrey Rakofsky (Assistant Professor in the Mood and Anxiety Disorders Program at Emory University School of Medicine in Atlanta, Georgia, USA) and Dr. Boadie Dunlop (Director of the Mood and Anxiety Disorders Program at Emory University) reviewed data from multiple trials and felt there was reasonably strong evidence compared to other supplements for bipolar depression[7]. Dr. Candida Fink, an experienced psychiatrist in New York (who co-authored a book for patients along with John Kraynak, who has lived experience of bipolar disorder) writes that most doctors would suggest 1-2 grams daily EPA for antidepressant effect[8]. SAMe SAMe is found in the body and is made from methionine, an amino acid found in foods. It has been widely studied in people with unipolar depression and bipolar disorder. It has been advised that SAMe should not be taken for bipolar depressive symptoms as SAMe may induce or worsen symptoms of mania. There is also concern that SAMe may interact with other supplements and medications by increasing levels of serotonin (a chemical produced by nerve cells), such as antidepressants, L-tryptophan, and St. John’s wort[9]. Dr William Walsh even states that some people with bipolar disorder could already have excessive SAMe in their bodies[3]. St. John’s Wort This yellow flower has been used as a medicine since ancient times as “the devil’s scourge” to ward off evil spirits. It was popular in the early 2000’s but popularity has waned due to concerns about lack of efficacy and risk of interaction with other medications[8] e.g. may reduce benzodiazepine effectiveness. Although many studies suggest St. John’s Wort can help treat mild-moderate unipolar depression, there doesn’t seem to be any strong evidence for treatment of bipolar depression. It is also risky to take along with other antidepressants due to the possibility of developing serotonin syndrome (this can cause tremor, diarrhoea and confusion) or triggering mania[1O]. Melatonin Melatonin is produced by the brain in reaction to the amount of ambient light, and thus helps us regulate our circadian rhythm. In turn, it is possible that the body rhythm helps regulate mood and vice versa. In people with mania, some studies suggest there is an early rise of lower melatonin levels, compared to healthy people and those with unipolar depression[11]. Early research shows that taking melatonin at bedtime increases sleep duration and reduces manic symptoms in people with bipolar disorder who also have insomnia. But there is also a risk that taking melatonin might make symptoms worse in some people with bipolar disorder[12]. For now, there is a lack of clear consensus on whether melatonin is helpful in bipolar disorder[11]. Other supplements Coenzyme Q10 - This vitamin-like substance is found in the body, and in small amounts in meats and seafood. It is commonly used for heart health. Early research shows that taking coenzyme Q10 may improve symptoms of depression in people over 55 years of age with bipolar disorder, but more research is needed[13]. 5-HTP – This substance is produced by the body and present in the seeds of an African plant called Griffonia simplicifolia. It increases serotonin production which itself affects mood, sleep and other body functions. There is a little evidence it can help with depression, anxiety and sleep, but just as with St. John’s Wort, if taken along with other antidepressants there is a risk of developing serotonin syndrome[8,14]. GABA – Made by the brain, GABA is thought to help anxiety and mood by blocking brain signals. However, there is little evidence to confirm its efficacy for mood and anxiety, nor consensus on safe dosage[15]. Inositil[7,8] – Mood stabilising medication like lithium and valproate are thought to work by stabilising the vitamin-like inositol’s signals within cells. Dr. Jeffrey Rakofsky and Dr. Boadie Dunlop found just one study that showed possibly efficacy. There is also a risk of triggering mania. Kava – Part of the pepper family, this herb is native to islands in the South Pacific. Many people take this for anxiety. There are mixed conclusions about efficacy, and it has been linked to severe liver injury, especially if combined with alcohol[16]. NAC – this substance is used by the body to make antioxidants (such as glutathione) that help the body’s cells recover from stress and damage. A group of researchers reviewed multiple studies and could not advise NAC as a safe, effective treatment for bipolar disorder[17]. Valerian - this has a distinctive odour and is extracted from a plant native to Europe and Asia. Out of 250 species V. officinalis is most commonly used. A review of nine trials was inconclusive for valerian’s sleep benefits. It can interact with benzodiazepines and other supplements such as St. John’s wort, kava, and melatonin[18]. Vitamins and minerals Vitamins B1, B6, B12 – there is a lack of good evidence to say these help people with bipolar disorder. Vitamin D – some studies show a link between depression and low vitamin D. However, but there is insufficient evidence to recommend it for bipolar depression[8]. Folic acid – also known as vitamin B9 and found in the form L-methylfolate, it has been shown in some studies to enhance antidepressant response in people with unipolar depression;19]. However, in a review, Dr. Jeffrey Rakofsky and Dr. Boadie Dunlop did not find good supporting data for folic acid in bipolar depression treatment[7]. Although taking folic acid does not appear to improve the antidepressant effects of lithium in people with bipolar disorder, WebMD suggests that taking folate with the medication valproate may improve the effects of valproate[20]. Dr Walsh comments that people with bipolar disorder may have folate under- or overload, so individual tailoring of folate supplementation may be beneficial[3]. Zinc – In earlier studies, lower blood levels of zinc were linked to depression. However, evidence seems to be pointing towards a use only in unipolar depression by increasing the efficacy of antidepressant therapy. Magnesium – A 1990 study of rapid cycling bipolar patients suggested that taking magnesium might have had an effect as strong as lithium in about half the people[21]. Another study in 2000 suggested that taking magnesium with the drug verapamil reduced manic symptoms better than verapamil alone[22]. More studies are needed. In short, with this array of frequently inconclusive data, it would be advisable to have a chat with your psychiatrist first before taking supplements for bipolar disorder. DietWhat we know People with bipolar disorder have a higher incidence of obesity, diabetes, high blood pressure, and unhealthy blood fat levels. The reasons for this may include:
There are even less well-understood possibilities, such as deliberately increasing sugar intake to reduce high levels of stress-induced blood cortisol [24]. An interesting recent study[25] looked at the eating habits of 113 well people with bipolar and 160 people without bipolar. Those with bipolar were generally less adherent to a Mediterranean diet than the non-bipolar group, and 74% of the bipolar group were overweight versus 68% in the non-bipolar group. The levels of blood sugar and triglycerides (a type of blood fat) were also higher in the bipolar group. A review of studies[24] looking at diet in bipolar disorder suggest the following:
What we can do As well as goal-setting towards regular healthier meals and snacks and restoring a regular circadian rhythm (there is more on this is in the October 2019 BipolarLife newsletter), the amount and type of food are also important for our mood and energy levels. Dr Ellen Frank, Professor of Psychiatry and Professor of Psychology at the University of Pittsburgh School of Medicine, Pennsylvania, recommends having three to four smaller meals per day to help keep mood and energy levels stable[26]. Depression and Bipolar Support Alliance (DBSA) suggests keeping a food and mood journal to see if a symptom is triggered by something dietary[27]. An example might be agitation and nervousness after a certain amount of caffeine, or broken sleep, low mood and poorer impulse control after alcohol. Given the above study findings, it may help to follow a portion-controlled Mediterranean-type diet (definitions vary) to help with mood and energy. This diet typically looks like this: HIGHER AMOUNTS: fruits, vegetables, legumes wholegrains and cereals nuts and seeds LOW-MODERATE AMOUNTS: healthy fats like olive oil and avocado instead of butter seafood, poultry, dairy little or no red meat If there are additional challenges to meet such as medication-related weight gain, you could also get support from your doctor and/or dietician. Don’t forget to check out online resources including:
If you think this article might help someone else too, please like and share Disclaimer: this content is not a substitute for individual medical advice. Abbreviations used: EPA = Eicosapentaenoic acid, DHA = Docosahexaenoic acid, ALA = Alpha-Linolenic Acid, SAMe = S-adenosyl-L-methionine 5-HTP = 5-Hydroxytryptophan GABA = Gamma aminobutyric acid, NAC = N-acetyl cysteine References1. Bauer, M., 2015. Common use of dietary supplements for bipolar disorder: a naturalistic, self-reported study. International Journal of Bipolar Disorders, [Online]. 3, 12. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451053/ [Accessed 27 October 2019].
2. Depression and Bipolar Support Alliance (DBSA). 2019. What You Need to Know About Dietary Supplements. [ONLINE] Available at: https://secure2.convio.net/dabsa/site/SPageServer/TR/pdfs/pdfs/devo/PageServer;jsessionid=00000000.app274a?NONCE_TOKEN=BB856198664DE4815756376A410964EA&pagename=wellness_depression_dietary_supplements]. [Accessed 27 October 2019]. 3. International Bipolar Foundation. (2019). Biochemistry Features of Bipolar Disorders and Advanced Nutrient Therapies. [Online Video]. 1 October 2016. Available from: https://www.youtube.com/watch?v=rQdsWVm9-sw. [Accessed: 27 October 2019]. 4. Muneer, A., 2019. Bipolar Disorder: Role of Inflammation and the Development of Disease Biomarkers. Psychiatry Investigation, [Online]. 13(1), 18–33. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701682 [Accessed 27 October 2019]. 5. US Department of Health and Human Services, Office of Dietary Supplements, National Institutes of Health. 2019. Omega-3 Fatty Acids. [ONLINE] Available at: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/. [Accessed 27 October 2019]. 6. WebMD. 2018. Bipolar Disorder Supplements. [ONLINE] Available at: https://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-supplements#3. [Accessed 27 October 2019]. 7. Psychiatric Times. 2014. To Supplement or Not to Supplement: That Is the Bipolar Depression Question. [ONLINE] Available at: https://www.psychiatrictimes.com/psychopharmacology/supplement-or-not-supplement-bipolar-depression-question. [Accessed 27 October 2019]. 8. Fink, C. and Kraynak, J., 2016. Bipolar Disorder for Dummies. 3rd ed. New Jersey, USA: John Wiley & Sons, Inc. 9. National Center for Complementary and Integrative Health (NCCIH). 2017. S-Adenosyl-L-Methionine (SAMe): In Depth. [ONLINE] Available at: https://nccih.nih.gov/health/supplements/SAMe. [Accessed 27 October 2019]. 10. Pipich, M, 2018. Owning Bipolar, How Patients and Families Can Take Control of Bipolar Disorder. Citadel Press. 11. De Berardis, D., 2015. The role of melatonin in mood disorders. ChronoPhysiology and Therapy, [Online]. 2015:5, 65-75. Available at: https://www.dovepress.com/the-role-of-melatonin-in-mood-disorders-peer-reviewed-fulltext-article-CPT [Accessed 27 October 2019]. 12. WebMD. 2018. Melatonin. [ONLINE] Available at: https://www.webmd.com/vitamins/ai/ingredientmono-940/melatonin. [Accessed 27 October 2019]. 13. WebMD. 2018. Coenzyme Q10. [ONLINE] Available at: https://www.webmd.com/vitamins/ai/ingredientmono-938/coenzyme-q10. [Accessed 27 October 2019]. 14. WebMD. 2018. 5-HTP. [ONLINE] Available at: https://www.webmd.com/vitamins/ai/ingredientmono-794/5-htp. [Accessed 27 October 2019]. 15. WebMD. 2018. GABA (Gamma-aminobutyric acid). [ONLINE] Available at: https://www.webmd.com/vitamins/ai/ingredientmono-464/gaba-gamma-aminobutyric-acid. [Accessed 27 October 2019]. 16. National Center for Complementary and Integrative Health (NCCIH). 2016. Kava. 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[ONLINE] Available at: https://www.webmd.com/vitamins/ai/ingredientmono-1017/folic-acid. [Accessed 27 October 2019]. 21. Chouinard, G., 2019. A pilot study of magnesium aspartate hydrochloride (Magnesiocard) as a mood stabilizer for rapid cycling bipolar affective disorder patients. Progress in Neuro-Psychopharmacology & Biological Psychiatry, [Online]. 14(2), 171-80. Available at: https://www.ncbi.nlm.nih.gov/pubmed/2309035 [Accessed 27 October 2019]. 22. Giannini, A., 2000. Magnesium oxide augmentation of verapamil maintenance therapy in mania. Psychiatry Research, [Online]. 93(1), 83-7. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10699232 [Accessed 27 October 2019]. 23. Sylvia, L., 2013. Nutrition, Exercise, and Wellness Treatment in bipolar disorder: proof of concept for a consolidated intervention. International Journal of Bipolar Disorders, [Online]. Available at: https://journalbipolardisorders.springeropen.com/articles/10.1186/2194-7511-1-24 [Accessed 27 October 2019]. 24. Łojko, D., 2018. Is diet important in bipolar disorder? Psychiatria polska, [Online]. 52(5), 783–795. Available at: http://psychiatriapolska.pl/uploads/images/PP_5_2018/ENGver783Lojko_PsychiatrPol2018v52i5.pdf [Accessed 27 October 2019]. 25. Łojko, D., 2019. Diet quality and eating patterns in euthymic bipolar patients.. European Review for Medical and Pharmacological Sciences, [Online]. 23(3), 1221-1238. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30779092 [Accessed 27 October 2019]. 26. DBSAlliance. (2019). Treatment Choices: Options for Bipolar Disorder. [Online Video]. 2 December 2014. Available from: https://www.youtube.com/watch?v=gzgi9Sr7twY&t=1137s. [Accessed: 10 October 2019]. 27. Depression and Bipolar Support Alliance (DBSA). 2019. Nutrition. [ONLINE] Available at: https://www.dbsalliance.org/wellness/wellness-toolbox/lifestyle/nutrition/. [Accessed 27 October 2019]. 28. CREST.BD Bipolar Wellness Centre. 2015. Why diet and nutrition are important to your quality of life. [ONLINE] Available at: http://www.bdwellness.com/Quality-of-Life-Areas/Physical/DietAndNutrition. [Accessed 27 October 2019]. "Content is fire; social media is gasoline.”
Do you work in a health centre/hospital, promote health products or run health-related content on a platform? Is high quality, curated content important to you? Then this article is for you. As a doctor with 20 years’ experience, I specialise in health writing for a wide audience. I’m ecstatic to see paternalistic attitudes dwindle in our profession. These days, health care providers are devoting more energy into patient-centred communication. But before we look at how to do it, let’s look at the consequences of poor communication with patients/clients. Dangers of inadequate communicationHere's an article looking at the consequences of not getting the message right. By the way, for ‘patient’ we can also extrapolate to ‘customer’ or ‘client. The authors concluded an aftermath of “unnecessary pain, in avoidable deaths, in poor health outcomes, in the prolongation of illnesses” and “costs in terms of the financial part of the equation, in large sums of money that get spent unnecessarily because of the communication breakdowns and barriers”. Sounds bad. What is patient-centred communication?This article published in PubMed Central® suggests that core concepts include:
When it comes down to written forms of such communication, I have some further recommendations for content. How to succeed
With globalisation, the rise of small businesses, and a tsunami of social media and digital communications, there is no ‘one size fits all’. Here are some interesting statistics from the Australian Communications and Media Authority (ACMA):
We can collaborate to make great contentAs a family physician, I'm able to write about most medical specialties. My particular interests are in mental health, women's health, health promotion, and chronic / complex medical issues. I’ve ghostwritten health articles, re-written articles for clients, composed content for my own websites, and produced patient information leaflets for people attending my clinics. I would also be delighted to work with patient and community groups too. If you’re after fresh writing backed by clinical experience, please head on over to my Health Writer Service page. Let's start the ball rolling today. @AliceLamWriter #generalpractice #healthcare #communication #patientexperience #patientempowerment #primaryhealthcare #health #patientsafety |
Dr Alice LamI'm a doctor who is passionate about writing quality health content. Archives
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